Provider Demographics
NPI:1689701682
Name:NEVAREZ-KELLS, LORETTA JO (NP)
Entity Type:Individual
Prefix:MS
First Name:LORETTA
Middle Name:JO
Last Name:NEVAREZ-KELLS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1760 E RIVER RD
Mailing Address - Street 2:SUITE # 350
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85718-5877
Mailing Address - Country:US
Mailing Address - Phone:520-519-7775
Mailing Address - Fax:520-519-7910
Practice Address - Street 1:19646 N 27TH AVE
Practice Address - Street 2:STE. # 403
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85027-4017
Practice Address - Country:US
Practice Address - Phone:623-587-4868
Practice Address - Fax:623-582-5300
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2016-12-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZRN047854363LX0001X
AZAP6844363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ619728Medicaid